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Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.
AIDS Care. 2017 Dec; 29(12):1473-1479.New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p < 0.001). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (>/=98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.
Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.
[Washington, D.C.], FHI 360, 2017 Nov. 2 p.This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
[Washington, D.C.], United States Agency for International Development [USAID], 2017 Jul. 3 p.The purpose of this technical update is to summarize current evidence and the World Health Organization (WHO) revised guidance regarding use of hormonal contraception (HC) by women at high risk of acquiring HIV. On March 2, 2017, WHO issued revised guidance on the use of progestogen-only injectables (norethisterone enanthate [NET-EN] and depot medroxyprogesterone acetate [DMPA], in both intramuscular [IM] and subcutaneous [SC] forms) by women at high risk of HIV acquisition. The recommendation was previously a Category 1 with a clarification, meaning there was no restriction on the use of the progestogen-only injectables, but women at high risk of HIV should be informed that use of those contraceptive methods may or may not increase risk of HIV acquisition. With the revised guidance, progestogen-only injectables are now classified as Category 2 for women at high risk of HIV acquisition. (excerpt)
Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study.
BMC Health Services Research. 2014; 14:525.BACKGROUND: The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. METHODS: Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. RESULTS: Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. CONCLUSIONS: Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.
[Geneva, Switzerland], WHO, 2016 Mar 2.  p. (WHO/ZIKV/MOC/16.2)The mosquito vector that carries the Zika virus thrives in warm climates and particularly in areas of poor living conditions. Pregnant women living in or travelling to such areas are at equal risk as the rest of the population of being infected by viruses borne by this vector. Maternal infection with Zika virus may go unnoticed as some people will not develop symptoms. Although Zika virus infection in pregnancy is typically a mild disease, an unusual increase in cases of congenital microcephaly, Guillain-Barré syndrome and other neurological complications in areas where outbreaks have occurred, has significantly raised concern for pregnant women and their families, as well as health providers and policy-makers. The aim of this document is to provide interim guidance for interventions to reduce the risk of maternal Zika virus infection and to manage potential complications during pregnancy. This guidance is based on the best available research evidence and covers areas prioritized by an international, multidisciplinary group of health care professionals and other stakeholders. Specifically, it presents guidance for preventing Zika virus infection; antenatal care and management of women with infection; and care during pregnancy for all pregnant women living in affected areas, with the aim of optimizing health outcomes for mothers and newborns. The guidance is intended to inform the development of national and local clinical protocols and health policies that relate to pregnancy care in the context of Zika virus transmission. It is not intended to provide a comprehensive practical guide for the prevention and management of Zika virus infections.
Global Health: Science and Practice. 2015 Sep 10; 3(3):352-357.Contraceptive effectiveness is the leading characteristic for most women when choosing a method, but they often are not well informed about effectiveness of methods. Because of the serious consequences of “misinformed choice,” counseling should proactively discuss the most effective methods-long-acting reversible contraceptives and permanent methods-using the WHO tiered-effectiveness model.
Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi.
Tropical Medicine and International Health. 2012 Apr; 17(4):507-17.OBJECTIVE: To understand reasons for suboptimal and delayed uptake of antiretroviral therapy (ART) by describing the patterns of HIV testing and counselling (HTC) and outcomes of ART eligibility assessments in primary clinic attendees. METHODS: All clinic attendances and episodes of HTC were recorded at two clinics in Blantyre. A cohort of newly diagnosed HIV-positive adults (>15 years) was recruited and exit interviews undertaken. Logistic regression models were constructed to investigate factors associated with referral to start ART. Qualitative interviews were conducted with providers and patients. RESULTS: There were 2398 episodes of HTC during 18,021 clinic attendances (13.3%) between January and April 2011. The proportion of clinic attendees undergoing HTC was lowest in non-pregnant women (6.3%) and men (8.5%), compared with pregnant women (47.2%). Men had more advanced HIV infection than women (79.7% WHO stage 3 or 4 vs. 56.4%). Problems with WHO staging and access to CD4 counts affected ART eligibility assessments; only 48% completed ART eligibility assessment, and 54% of those reporting WHO stage 3/4 illnesses were not referred to start ART promptly. On multivariate analysis, HIV-positive pregnant women were significantly less likely to be referred directly for ART initiation (adjusted OR: 0.29, 95% CI: 0.13-0.63). CONCLUSIONS: These data show that provider-initiated testing and counselling (PITC) has not yet been fully implemented at primary care clinics. Suboptimal ART eligibility assessments and referral (reflecting the difficulties of WHO staging in primary care) mean that simplified eligibility assessment tools are required to reduce unnecessary delay and attrition in the pre-ART period. Simplified initiation criteria for pregnant women, as being introduced in Malawi, should improve linkage to ART. (c) 2012 Blackwell Publishing Ltd.
London, United Kingdom, IPPF, 2012 May.  p.Obtaining the consent of your client before treating them is a cornerstone of good medical practice and in most countries, a legal requirement, and the process of obtaining it is a specific example of when health professionals must apply the concept of evolving capacity. To be fully included in the decision-making process and to give informed consent, young people need accurate and comprehensive information presented in an accessible manner.
London, United Kingdom, IPPF, 2012 May.  p.Evolving capacity is about individual development and autonomy -- it refers to the way that each young person gradually develops the ability to take full responsibility for her or his own actions and decisions. This publication highlights important issues for health professionals to consider in finding the balance between protecting young clients and enabling them to exercise autonomy.
London, United Kingdom, IPPF, 2011 Mar.  p.Confidentiality is crucial in the provision of youth friendly services. Privacy and confidentiality are distinct concepts. Confidentiality ensures privacy. The promotion of young people's sexual and reproductive health can only be achieved through providing confidential services that encourage them to seek preventative care and counselling.
London, United Kingdom, IPPF, 2011 Oct.  p.Young people are not a single homogenous group, but a diverse population whose sexual and reproductive health needs are complex, shifting and varied. Youth-friendly service delivery should be based on an understanding of and respect for each person's unique social, cultural and economic identity.
London, United Kingdom, IPPF, 2011 Mar.  p.Sexuality is a fundamental aspect of human life that refers to gender roles and identities, sexual orientation, intimacy and pleasure. Open, free expression of sexuality is central to every individual's well-being. Accepting these realities is the starting point for adopting a sex-positive approach to youth-friendly sexual and reproductive health services.
[Geneva, Switzerland], WHO, 2010 Mar.  p.Adapted from the WHO's Decision-Making Tool for Family Planning Clients and Poviders, this flip-chart is a tool to use during family planning counseling or in group sessions with clients. It can: help your clients choose and use the method of family planning that suits them best; give you the information you need for high-quality and effective family planning counselling and care; help you know who may need referral.
Journal of Midwifery and Women's Health. 2011 Nov; 56(6):598-607.In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC. (c) 2011 by the American College of Nurse-Midwives.
Journal of Women's Health. 2011 Jun; 20(6):825-8.Abstract Women with unintended pregnancies are more likely to experience poor pregnancy outcomes. For women with medical conditions, unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception.
Engaging informal providers in TB control: what is the potential in the implementation of the WHO stop TB strategy? a discussion paper.
World Health and Population. 2011; 12(4):5-13.The World Health Organization (WHO) Stop TB Strategy calls for involvement of all healthcare providers in tuberculosis (TB) control. There is evidence that many people with TB seek care from informal providers before or after diagnosis, but very little has been done to engage these informal providers. Their involvement is often discussed with regard to DOTS (directly observed treatment - short course), rather than to the implementation of the comprehensive Stop TB Strategy. This paper discusses the potential contribution of informal providers to all components of the WHO Stop TB Strategy, including DOTS, programmatic management of multi-drug-resistant TB (MDR-TB), TB/HIV collaborative activities, health systems strengthening, engaging people with TB and their communities, and enabling research. The conclusion is that with increased stewardship by the national TB program (NTP), informal providers might contribute to implementation of the Stop TB Strategy. NTPs need practical guidelines to set up and scale up initiatives, including tools to assess the implications of these initiatives on complex dimensions like health systems strengthening.
Adaptation of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use for use in the United States.
Contraception. 2010 Jul; 82(1):3-9.BACKGROUND: The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions. STUDY DESIGN: CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence. RESULTS: The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions. CONCLUSION: The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices. Published by Elsevier Inc.
[Research Triangle Park, North Carolina], FHI, 2009.  p.Clients should be scheduled for NET-EN reinjections every 8 weeks. According to the 2008 WHO guidelines, a client can receive a reinjection if she is up to 2 weeks early or 2 weeks past her scheduled reinjection date, without ruling out pregnancy. Clients arriving after the reinjection window may also be eligible if pregnancy can be ruled out. The steps in this aid should be followed for clients who are returning for reinjection. For clients who want an injection for the first time, "Checklist for Screening Clients Who Want to Initiate NET-EN" should be used.
[Research Triangle Park, North Carolina], FHI, 2009.  p.Clients should be scheduled for DMPA reinjections every 13 weeks. According to the 2008 WHO guidelines, a client can receive a reinjection if she is up to 2 weeks early or 4 weeks past her scheduled reinjection date, without ruling out pregnancy. Clients arriving after the reinjection window may also be eligible if pregnancy can be ruled out. The steps in this aid should be followed for clients who are returning for reinjection. For clients who want an injection for the first time, "Checklist for Screening Clients Who Want to Initiate DMPA".should be used.
Mera. 2008 Sep; iii-vi.When a woman chooses a contraceptive method, effectiveness is often the most important characteristic she considers. Knowing the risks and benefits of each method, including its effectiveness, is necessary for a woman to make a truly informed decision. Yet, many women do not understand how well various methods protect against pregnancy. Health professionals usually explain effectiveness by informing women of the expected pregnancy rates for each method during perfect use (when the method is used consistently and correctly) and during more typical use (such as when a woman forgets to take all of her pills). However, the World Health Organization (WHO) has recently endorsed a simple evidence-based chart that healthcare providers can use to help women understand the relative effectiveness of different methods -- a concept that is much easier for most people to grasp. Key points of this article are: 1) Clinicians play an important role in ensuring that women understand the concept of effectiveness -- a key element of informed choice; 2) Women are able to understand the relative effectiveness of contraceptive methods more easily than the absolute effectiveness of a particular method; and 3) A new chart that places the methods on a continuum from least to most effective can help health professionals better communicate about contraceptive effectiveness.
Lancet. 2007 Dec 1; 370(9602):1808-1809.Important questions about implementation of the new guidance by WHO and UNAIDS on provider-initiated HIV testing and counselling were raised by Daniel Tarantola and Sofia Gruskin. Their comments and those by other critics centre on individuals' rights to confidentiality, to refuse testing, and to not disclose their status if they fear negative consequences. We are concerned that a singular focus on the individual's rights of refusal overlooks the rights of the individual's sexual partners to protect themselves from HIV. Human rights and public health will be best served by an ethical framework which recognises that both persons in a sexual relationship or exchange have equal rights and responsibilities for their mutual pleasure and protection. Further, these individual rights are meaningless unless each partner respects the rights of the other. Protection of the human rights of both partners needs more commitment from health systems, and from societies, than simply ensuring informed consent and confidentiality. (excerpt)
Lancet Infectious Diseases. 2007 Jul; 7(7):446.WHO and UNAIDS have issued new guidance on scaling up informed voluntary HIV testing and counselling in health facilities globally. The guidance promotes provider-initiated HIV testing, alongside existing patient-initiated HIV testing, with a view to ensuring earlier diagnosis, reducing transmission, and maximising the benefits of treatment. At a press conference in London, UK, Kevin De Cock (WHO, Geneva, Switzerland) told journalists: "WHO now recommends that in countries with generalised epidemics, all patients - with or without symptoms -who present to health services for whatever reason, should be offered testing". In countries with low-level HIV epidemics, the testing of all patients is now recommended at specific health services catering for at-risk groups. Additionally, all patients presenting to a health service with symptoms suggestive of HIV infection should be encouraged by health professionals to undergo testing. According to WHO, too many opportunities to diagnose HIV infection are being missed. (excerpt)
Guidelines for adaptation of the WHO Orientation Programme on Adolescent Health for Health Care Providers in Europe and Central Asia.
New York, New York, United Nations Population Fund [UNFPA], Division for Arab States, Europe and Central Asia, 2006. 25 p.The Orientation Programme on Adolescent Health for Health Care Providers (OP) was developed by the Department of Child and Adolescent Health and Development, WHO in 2003. The aim of the OP is to orient health care providers to the special characteristics of adolescence and to appropriate approaches in addressing some adolescent-specific health needs and problems. The OP aims to strengthen the abilities of the health care providers to respond to adolescents more effectively and with greater sensitivity. The OP can significantly contribute to building national and regional capacity on adolescent health and development. (excerpt)
Evaluation of the World Health Organization's family planning decision-making tool: Improving health communication in Nicaragua.
Patient Education and Counseling. 2007 May; 66(2):235-242.The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision. (author's)